Evidence map›Paper›PMID 41922986›Full record

Trial reportBMC primary care2026

Clinical and cost effectiveness of nurse led-structured management of diarrhoea predominant irritable bowel syndrome in primary care (Lincolnshire POACHER study); a randomised control trial.

H Jervoise N Andreyev, Debbie Jeffrey, Kay Rodgers, Anna Jones, Alexandra Carlin, A Niroshan Siriwardena, Sarah Redsell, Katy Ward, Judith Cohen, Valerie Preston and 8 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

H Jervoise N AndreyevDept of Gastroenterology, Lincoln County Hospital, LN5 2QY, Lincoln, UK. jervoiseandreyev@gmail.com.
Debbie JeffreyR&I team, Lincolnshire Community Health Services NHS Trust, Beech House, Witham Park, Lincoln, LN5 7HJ, UK.
Kay RodgersR&I team, Lincolnshire Community Health Services NHS Trust, Beech House, Witham Park, Lincoln, LN5 7HJ, UK.
Anna JonesR&I team, Lincolnshire Community Health Services NHS Trust, Beech House, Witham Park, Lincoln, LN5 7HJ, UK.
Alexandra CarlinSchool of Health Sciences, The University of Nottingham, Nottingham, NG7 2HA, UK.
A Niroshan SiriwardenaSchool of Health and Care Sciences and Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, LN6 7TS, UK.
Sarah RedsellSchool of Health Sciences, The University of Nottingham, Nottingham, NG7 2HA, UK.
Katy WardR&I team, Lincolnshire Community Health Services NHS Trust, Beech House, Witham Park, Lincoln, LN5 7HJ, UK.
Judith CohenHull Health Trials Unit, University of Hull, Hull, HU6 7RX, UK.
Valerie PrestonPatient and public representatives, Lincoln, UK.
Rose BrownPatient and public representatives, Lincoln, UK.
Barbara Chris' WoodheadPatient and public representatives, Lincoln, UK.
Murray SmithAberystwyth Business School, Aberystwyth University, Aberystwyth, SY23 3FL, Wales, UK.
Sunil HindochaHeart of Lincoln Medical Group, Portland Street, Lincoln, Lincolnshire, LN5 7LB, UK.
Shihua ZhuSenior Research Fellow in Econometrics and Health Economics, Community and Health Research Unit, University of Lincoln, Lincoln, LN6 7TS, UK.
Tanja K KleinhappelSchool of Health and Care Sciences and Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, LN6 7TS, UK.
Zahid AsgharSchool of Health and Care Sciences and Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, LN6 7TS, UK.
Graham LawSchool of Health and Care Sciences and Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, LN6 7TS, UK.

Funding

National Institute for Health and Care Research NIHR200455
6 · The paper itself

Abstract

backgroundIrritable Bowel Syndrome (IBS) is common and impairs quality of life. IBS is usually diagnosed using symptom-based criteria. Treatment leads to remission in < 50%.

methodsA randomised controlled trial was conducted in primary care to evaluate whether patients meeting Rome IV criteria for diarrhoea-predominant irritable bowel syndrome (IBS), presenting to primary, care benefit from a stepwise investigative approach with treatments tailored to alternative diagnoses. Participants were randomised 1:1 to management by general practitioners encouraged to follow National Institute of Health Care Excellence IBS Guidelines (controls) or structured investigation and treatment of newly diagnosed conditions (intervention). The primary end point was IBS Symptom Severity Score (IBSSSS) change.

resultsBetween October 2020- September 2023, 113 participants 81 female, mean age 36 years, 62 (70%) with severe symptoms, from 44 Lincolnshire practices were randomised, of whom 81 completed follow-up (28% attrition). Study arms were balanced. Mean IBSSSS (SD) decreased from 303.00 (92.85) to 234.05 (114.20) in the control arm and from 312.00 (72.59) to 126.49 (85.26) in the intervention arm. The absolute adjusted between-group mean difference was − 112.29 points (95% CI-151.68 to -72.91; p < 0.0001], corresponding to a large standardised effect size (Hedges’ g = 0.95). Improved quality of life (p < 0.001) and anxiety (p = 0.04) also favoured intervention. In 74% (n=32/43) of intervention participants completing the study, appropriate treatment of alternative diagnoses was reported to lead to sustained clinical improvement. Diagnoses included bile acid diarrhoea (n=18, 42%), small intestinal bacterial overgrowth (n=13, 30%), fructose intolerance (n=8, 19%), exocrine pancreatic insufficiency (n=3, 7%), lactose intolerance (n=2, 5%) and coeliac disease (n=1, 2%) with more than one condition in 12 participants (28%). Advice on lifestyle (n=13, 30%) and toileting (n=15, 35%) provided additional sustained benefit. Mean intervention costs were £1396 compared to £315 for controls. The number of appointments did not correlate with final IBSSSS (p=0.21).

conclusionsDespite significant findings, under-recruitment, higher-than-anticipated loss to follow-up and lack of blinding may overestimate the benefits found (prospective trial registration: 14th July 2020, ISRCTN87945798).

Indexed as

DiarrheaIrritable Bowel SyndromePrimary Health CareAdultCost-Benefit AnalysisCost-Effectiveness AnalysisFemaleHumansMaleMiddle AgedQuality of LifeSeverity of Illness IndexBile acid diarrhoeaBloatingDefaecationDiarrhoeaEndoscopyFlatulenceFructose intoleranceHealth economicsICERIncremental Cost Effectiveness RatioIrritable Bowel SyndromePainPancreatic insufficiencyPrimary careQALYQuality of lifeRandomised trialSmall intestinal bacterial overgrowth

Identifiers

PMID41922986
PMCPMC13169618

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.